Anesthesia Coding Alert

Question: I'm confused on how to use a prolonged service code for E/M services. Can you clarify when it is appropriate to use a prolonged code versus a higher level E/M?

Florida Subscriber

Answer: The difference is medical necessity. For example, a visit in which the E/M medical necessity level meets the criteria for 99214 (Office or other outpatient visit for the evaluation and management of an established patient ... physicians typically spend 25 minutes face-toface with the patient and/or family) takes 60 minutes.

This visit would be eligible for an additional prolonged service code of 99354 (Prolonged physician service... first hour ...) with 99214.